Introduction: Globally, only 13.8% of hypertensive patients have their blood pressure (BP) controlled. Trials testing implementation strategies to overcome barriers to BP control have produced mixed results. Providers who deliver the intervention may play an important role in implementation strategy success. This meta-analysis aimed to determine which provider-led interventions are most effective for BP reduction.
Methods: We searched Medline and Embase (through September 2017) for randomized controlled trials of various provider-led implementation strategies targeting barriers to hypertension control in hypertensive patients. Seventy-four trials with 22,180 hypertensive participants met our eligibility criteria and were included in this analysis. These trials were grouped by intervention provider, and the effects of the intervention on BP change were combined using random effects models.
Results: Pharmacist-led health coaching and team-based care had the greatest reduction in systolic and diastolic BP. Nurse- and community health worker-led interventions also resulted in significant reductions in BP. Interventions led by multiple providers were less effective for BP reduction. Research staff-led interventions were also effective at reducing BP but questions of sustainability persist.
Conclusions: Pharmacists are most effective for the delivery of implementation strategies for BP control among patients with hypertension. Nurse- and community health worker-led interventions were also effective for BP reduction. Pharmacist-, nurse- and community health worker-led interventions should be prioritized in future BP control efforts.